This study evaluated the ability of subjects at 3 levels of expertise, expert physicians, residents and medical students, in the acquisition, representation, and utilization of patient information in the context of solving a complex medical problem. Each subject interviewed a volunteer medical outpatient and was subsequently requested to provide a differential diagnosis. The doctor-patient dialogue was analyzed using cognitive methods of discourse analysis. These methods were used to characterize differences in the content and nature of the history-taking process and in the development of problem representations. The study characterized differences at two levels of representation, observations and findings. Observations are the minimal semantic units of the doctor patient discourse. Findings are higher order units that derive meaning in specific medical contexts. / Differences were found between groups of subjects in the accuracy of diagnoses and in the qualitative nature of representations. These differences were manifested most clearly in terms of a series of efficiency measures designed to characterize the ability of subjects to generate findings. In general, the expert physicians were more selective in the elicitation and processing of critical and relevant findings. An attempt is made to characterize these differences in terms of the strategies used to acquire and represent patient information.

There is ample evidence that clinical communication skills deteriorate in medical students without specific training, but are improved by training. However, little is known about how well-equipped students are to communicate with patients on entering medical school, and there is limited evidence about whether all students improve with tuition in communication skills. This thesis describes a longitudinal study into these issues at the University of Otago�s Medical School. It was hypothesised that the majority of participants would demonstrate significant improvement in communication skills over their first two phases of specific tuition in communication. However, a small minority of participants were expected to fail to develop adequate skills in communication over this time, and the researcher wished to investigate whether any of the variables measured at baseline (demographic characteristics, personal qualities, academic abilities, and demonstrated interaction and interview observation skills) would predict those participants who developed superior communication skills, or who failed to demonstrate sufficient improvement by the end of eighteen months of medical education. Participants were 232 new entrants to the Otago Medical School programme, who were evaluated at three time points over the first eighteen months of their medical training. After completing a range of baseline measures (including a pre-training videotaped interview with a simulated patient role-played by an actor), participants completed two phases of communication skills training and, at the end of each phase, undertook a further videotaped interview. Interviews were marked by trained raters, using a novel assessment tool, the Brown-Peace Interview Marking Schedule, developed specifically for this purpose. Actors and participants themselves also evaluated each interview. Results showed that there was considerable variation in participants� abilities to perform the pre-training interview, indicating that the communication skills required in a clinical setting were not present in the majority of participants before training. Analysis of participant performance over time indicated that, while certain skills improved with training (e.g., receptive listening skills, non-verbal expression, and degree of structure in the interview) others did not improve significantly (e.g., responsiveness to the patient�s needs). As a group, participants benefited from the training, but a small sub-group of participants exhibited significant deficits in communication, even after two phases of communication skills training. It was easier to predict those participants who would develop superior communication skills than those who would continue to experience difficulties with simulated interviews. However, a small number of qualities (such as lack of familiarity with the English language, and high levels of personal qualities such as aloofness) were useful predictors of poor performance in the videotaped interviews. Further research could clarify whether the same personal qualities influence student performance in later interviews, once students have had more experiential training and opportunities to practise interviewing in a range of settings. In terms of the practical implications of the research findings, a number of issues are highlighted, such as the range of skills required of those who teach and evaluate communication skills. Recommendations are made regarding the timing, content and implementation of communication skills training for medical students.

Thesis (Ph. D.)--University of Sydney, 2007. / Title from title screen (viewed 17 Apr. 2007). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Physiotherapy, Faculty of Health Sciences. Includes bibliographical references. Also available in print form.

Thesis (M.Ed.)--University of Adelaide, Dept. of Education, 1999. / Errata inserted facing title page. Bibliography: leaves 124-135.

Thesis (Ph.D.)--Alliant International University, California School of Professional Psychology, San Francisco Bay, 2001. / Includes bibliographical references (leaves 72-84).

Thesis (Ph. D.)--University of Sydney, 2006. / Title from title screen (viewed 16 May 2007). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Physiotherapy, Faculty of Health Sciences. Includes bibliographical references. Also available in print form.

Thesis (Ph. D.)--University of Sydney, 2006. / Title from title screen (viewed 30 May 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Public Health, Faculty of Medicine. Degree awarded 2006; thesis submitted 2005. Includes bibliographical references. Also available in print form.

Thesis (M.A.)--Missouri State University, 2008. / "May 2008." Includes bibliographical references (leaves 87-96). Also available online.

Thesis (M.IS.(Information Science))--University of Pretoria, 2008. / Includes bibliographical references.

Thesis (Ph. D.)--Rutgers University, 2009. / "Graduate Program in Communication, Information and Library Studies." Includes bibliographical references (p. 187-196).